Tutorial 7 - Health promotion Flashcards
What are the 6 stages in the behavioural change model ?
- Pre contemplation : Not worried about lifestyle choices at all. Pros»_space;»> cons
- Contemplation : Still enjoying using BUT starting to notice some issues - weighing up how changing habits could help.
Pros >? cons - Preparation : pros < cons - actively thinking about changing lifestyle choice,.
- Action : Have implemented change i.e. cutting down alcohol intake.
- Maintenance : Been in action stage a while now, new lifestyle change is now feeling a lot more easier / normal i.e. no cravings anymore.
- Relapse : Return to lifestyle issue repeatedly VS Lapse : single return i.e. drinking a beer when abstaining.
Relapse and lapse are very important, useful and likely! They should be explained to the patient as a brilliant learning opportunity - which they should explore to prevent it affecting their maintenance stage in the future.
What is the behaviour change wheel ?
What are the current guidelines for alcohol consumption ?
- 14 units a week spread over at least 3 days ( with several alcohol free days ) for both males and females.
- If pregnant no alcohol should be drank until childbirth, if trying to conceive than both partners should drink less than 14 units / not drink to improve sperm quality.
- Advice that drinks often have their units written on the label, i.e. a can of beer has around 2 units.
What are some drug regimes that can be used for alcohol withdrawal ?
- Prescribe a benzodiazepine such as lorazepam for a course of 7 - 10 days to help with the withdrawals - do not give large amounts at once due to risk of OD.
- After successful withdrawal prescribe disulfiram with psychological intervention to stop prevent lapse / relapse.
What are some non pharmacological interventions that can be used for alcohol withdrawal ?
- Self help groups i.e. alcoholics anonymous
- Cognitive behavioural therapy (CBT) - this identifies the causes of you drinking and helps re - wire how you think of these scenarios i.e. “ work is so stressful - so I have to drink to cope” –> “Work Is stressful for many people, and many people don’t drink to deal with the stress, I can also be one of those people” .
- Drinking diary - Scribble down what you drink / when - the reason why you are drinking.
What are the main screening tools for alcohol dependance ?
- CAGE ( cut, annoyed, guilty, eye opener - morning ) - if score is above 2 investigate further.
- SADQ quiz
- AUDIT ( 10 question questionnaire )
What are some medications that elderly people are often on, that you should safety net the risk of drinking alcohol with ?
- Opioids / sedatives - Increases risk of respiratory depression
- NSAIDs - Increases risk of peptic ulceration / heartburn
- Anticoagulants i.e. warfarin - increases metabolism of the drug and hence further increases bleeding risk.
What are the main treatment goals for alcohol dependance ?
- 1st line : Abstinence
- 2nd line : Moderation
- 3rd line : Risk reduction
- Throughout consultation use motivational interviewing.
What is wernickers encephalopathy and Korsakoff syndrome ?
- Vitamin B1 / thiamine deficiency
- Thiamine when converted to active form helps with glucose metabolism.
- Abnormal metabolism cause brain pathology.
How do wernickers encephalopathy and Korsakoff syndrome present ?
- Wernickers encephalopathy ( affects thalamus and hypothalamus ) : ataxia, nystagmus and confusion
- Korsakoff syndrome (maxillary body and hippocampus) : Inability to make new memories, memory loss, confabulations (making up memories ) and hallucinations
- Symptoms based on part of brain damaged by the condition.
What are risk factors for wernickers encephalopathy and Korsakoff syndrome present ?
- Anything that can cause thiamine deficiency :
- Chronic alcohol related liver cirrhosis
- GI surgery
- inflammatory bowel disease i.e. crohns.
How are wernickers encephalopathy and Korsakoff syndrome diagnosed ?
- Clinical features
- Thiamine levels and LFT’s
- MRI scan for degeneration of the maxillary bodies
What is the treatment for wernickers encephalopathy and Korsakoff syndrome ?
- Thiamine replacement orally
- Advice on better diet
- Alcohol abstinence
What alcohol withdrawal symptoms can you worn patients about ?
- Anxiety, sweating, hypertension, tachycardia, hallucinations and insomnia.
What are some drug regimes to help with smoking cessation ?
- NRT ( patches, ora lozenges, nasal / mouth sprays, chewing gum
- Bupropion (zyban)
- Varenicline (champix)
- E- cig
What withdrawal symptoms should patients be warned about ?
- Depression , anxiety, cravings, difficulty concentrating, insomnia and weight gain.
What is the recommendation of the eat well guide ?
What are the NHS guidelines for healthy weight and waist circumference ?
- BMI
- Waist ( measured mid way between hips and bottom of ribs) should be less than 37 inches for males and 31.5 inches for females - higher predisposes to heart disease, stroke and diabetes !
